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Calls for improvement in transgender care

Tagged In:  Mental Health, NHS

As LGBT History Month draws to a close, the debate continues about whether transgender people are being treated fairly by the NHS.

There has been much recent press coverage about the need to improve NHS care for transgender people. Although concerns have been raised in the past, leading to the Government's Transgender Equality Action Plan of 2011, the debate was reignited by a recent report by the House of Commons Women and Equalities Committee. "We have found that the NHS is letting down trans people, with too much evidence of an approach that can be said to be discriminatory and in breach of the Equality Act," says the report.

Testimony from senior doctors linked the poor treatment of transgender people with lack of training amongst NHS staff. "My experience, working with GPs and secondary care physicians, is that, overall, people working in the service try to be empathic; they are certainly sympathetic, but they lack a great deal of background knowledge about gender incongruence and dysphoria," commented Dr John Dean, Chair of the NHS England Committee on Gender Identity Services. "It is something that is not covered in any detail in medical training."

In a 2007 survey, 60% of transgender respondents felt their GPs and other clinicians wanted to be more helpful but felt unable to do so because of a lack of training and information.

In her evidence to the Committee, Women and Equalities Minister Nicky Morgan insisted the Government was not complacent about the challenges facing transgender people. " We have got to have an act that will last a little bit of the test of time and be broad enough to deal with all the different issues that have come up even in the five years since the Equality Act," she argued.

Apart from training for doctors, nurses and other NHS frontline professionals, one of the key issues seems to be waiting times. It can take up to 18 months between referral and initial consultation at a gender identity clinic and the lead time for sex change operations can be three to four years. These delays can lead to transgender people suffering mental health issues. 

NHS England says the problem is mainly due to a shortage of 'suitably qualified staff' and has provided additional funding to help speed up access to services. "We recognise the need to bring down waiting times, and to this end we have met with all gender identity clinics to agree plans to increase capacity from April 2016," confirmed Will Huxter, Chairman of NHS England's Gender Identity Services Task and Finish Group. 

Encouraging signs

Dealing with young people aged up to 18, the Gender Identity Development Service (GIDS), based at London's Tavistock and Portman NHS Trust, takes referrals from across the UK, usually through a local Child and Adolescent Mental Health Service (CAMHS). With a remit to 'understand the nature of the obstacles in the development of gender identity, and to try minimise their negative influence', the Service has a multi-disciplinary team, including child and adolescent psychiatrists, psychologists, psychotherapists and paediatricians.

As for helping mental health professionals provide appropriate support to transgender adults, the Royal College of Psychiatrists has issued Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria.

There are also positive signs from other NHS trusts. In Brighton and Hove the Clinical Commissioning Group (CCG) has reacted to the findings of the parliamentary inquiry by developing an online guide for GPs to help them support transgender patients. And in Scotland, NHS Ayrshire and Arran has recently won the LGBT Charter Foundation's award for its commitment to LGBT equality.

In November last year the Government issued two guides for businesses: Recruiting and retaining transgender staff and Providing services for transgender customers. With a 500% increase in referrals to the GIDS over the last five years, similar initiatives to help the NHS deal more effectively with transgender people will be widely welcomed. 

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